From the FDA Drug Label
Instruct patients to take levothyroxine sodium tablets as a single dose, preferably on an empty stomach, one-half to one hour before breakfast with a full glass of water to avoid choking or gagging. The FDA drug label does not answer the question.
From the Research
Levothyroxine can be taken at night, and this timing may improve its absorption and effectiveness for some individuals. The traditional recommendation has been to take levothyroxine in the morning on an empty stomach, 30-60 minutes before breakfast, but recent research suggests that nighttime dosing can be equally effective or even superior in some cases 1. This is because the digestive system is generally less active during sleep, which may allow for better absorption of the medication. Additionally, many foods, supplements, and medications that can interfere with levothyroxine absorption (such as calcium, iron, antacids, and certain foods) are less likely to be present in your system at bedtime.
Some key points to consider when taking levothyroxine at night include:
- Taking the medication at least 3-4 hours after your last meal to minimize potential interactions with food
- Being consistent with the timing of your dose to maintain stable thyroid hormone levels
- Having your thyroid levels checked after making the change, as your dosage requirements might change
- Consulting with your healthcare provider before changing your medication schedule
It's also important to note that individualized dosing regimens may be considered based on patient convenience and preference, as suggested by a recent meta-analysis with trial sequential analysis of randomized clinical trials 1. However, it's essential to prioritize the most recent and highest quality study, which in this case is the 2025 study published in the Endocrine journal 1.
In terms of potential benefits and risks, some studies have explored the effects of combination therapy with levothyroxine and liothyronine on quality of life and patient satisfaction 2, 3, 4. However, the primary concern is the impact of timing and scheduling on levothyroxine adherence to hypothyroidism control, which is addressed by the most recent study 1.
Overall, the decision to take levothyroxine at night should be made in consultation with a healthcare provider, taking into account individual circumstances and potential interactions with other medications or health conditions.